What’s that blemish, and how do I treat it?
If you’re prone to acne, you may have asked yourself these questions while peering at your skin in a magnified mirror.
The truth: The answer isn’t always clear-cut. Acne takes many forms. Generally speaking, each one requires a unique approach.
While it may seem tempting, it’s best not to go slathering on salicylic acid for every bump or red spot.
If acne persists and has a corrosive effect on your confidence, it’s only natural that you’d want to treat it in the most effective way possible.
First, identify what you’re dealing with before putting a targeted skin care plan in place. Read on to get two expert opinions on the best solutions for each acne type.
Is it inflammatory or non-inflammatory?
First, you’ll want to answer this question.
“There are two main types of acne: inflammatory and non-inflammatory,” says Natalia Spierings, a consultant dermatologist and the author of “Skintelligent: What You Really Need to Know to Get Great Skin.”
Non-inflammatory acne is a more common and less severe form of acne. It occurs when your pores become clogged, and it includes both whiteheads and blackheads.
Inflammatory acne is typically more severe and painful. It causes red, swollen, and sore bumps, and the pimples contain pus, dead skin cells, bacteria, and sebum (oil).
It includes:
- papules and pustules
- nodular acne
- cystic acne
Spierings says it’s important to know the difference between these two forms because treatment for inflammatory and non-inflammatory acne is very different.
Whiteheads
Most people are familiar with whiteheads. They’re small, raised bumps on the skin that are white or yellowish in color.
Hassan ElHusseini, a dermatologist at Dr. Kayle Aesthetic Clinic Dubai, says whiteheads are one of the most common forms of acne.
“Whiteheads occur when a pore becomes clogged with a mix of dead skin cells and sebum,” says ElHusseini.
Though they’re called whiteheads, they may also appear the same color as your skin.
How to treat whiteheads
First things first, resist the urge to pick your whiteheads. ElHusseini says this will only spread bacteria to other pores.
Next, look to over-the-counter treatments, like salicylic acid, benzoyl peroxide, and retinoids. ElHusseini also believes adding witch hazel to your skin care routine may help.
“Witch hazel is an effective natural astringent that can help dry up whiteheads and other types of acne,” he explains.
You’ll find witch hazel in many face washes and cleansers, but it’s probably best used as a toner. Simply wet a cotton pad or reusable face pad with it, and swipe it across your face.
If you’re new to this skin care ingredient or have sensitive skin, ElHusseini suggests proceeding with caution.
“Witch hazel can be a little too astringent for some sensitive skin,” he warns. If you plan on using witch hazel, you should consult a dermatologist first.
Blackheads
You may have spotted a smattering of little black dots around your forehead, nose, and chin. These are blackheads, a type of comedonal acne.
Like whiteheads, blackheads are also caused by clogged pores. However, unlike whiteheads, the clogged pore full of oil and skin cells is open to the air.
“The [clogged pores] change color when they come into contact with oxygen, which gives them their dark appearance,” he says.
How to treat blackheads
The first line of defense is management. See a board certified dermatologist to create an appropriate medical management regimen.
When it comes to targeting blackheads at home, cleansing with salicylic acid and unplugging your pores with a topical retinoid can help.
“The underlying problem with comedonal acne is that the skin cells lining the hair follicle are too sticky and don’t shed properly,” says Spierings. “The only treatments that are known to change this stickiness problem are retinoids.”
In some cases, your dermatologist may recommend professional extraction.
During this process, a skin care professional will most likely use a metal tool to remove buildup from within the pores.
“This can be a fantastic way to kick off your cleansing journey, but ultimately facials are a temporary fix,” ElHusseini explains. “You’ll need to keep up a good skin care regimen between sessions.”
If you’re considering professional extraction, it’s important to discuss it with a dermatologist first. They can put a medical management program in place and may recommend extractions in a limited capacity.
Be sure to check out the credentials of the professional performing your extraction too, as improper treatment can lead to scarring.
Papules and pustules
“Papules are the swollen red bumps that so many of us associate with ‘typical’ breakouts. They develop when excess oil and dead skin cells clog your pores,” explains ElHusseini.
The walls of the pore can rupture due to pressure buildup.
After a few days, papules may become another type of acne called pustules. These appear as bumps on the skin that contain pus.
How to treat papules and pustules
Keeping up good skin hygiene habits is your first line of defense. After that, provenTrusted Source over-the-counter and prescription products that fight inflammatory acne can help.
Topical treatments commonly recommended by dermatologists include:
- retinoids
- benzoyl peroxide
- beta hydroxy acids (BHAs), like salicylic acid
- topical dapsone
Systemic therapies commonly recommended by dermatologists include:
- isotretinoin
- minocycline
- doxycycline
- an oral contraceptive containing low dose estrogen
- spironolactone
“While a certain amount of sebum is necessary and healthy, too much can lead to clogged pores and breakouts. So keep your pores clear with a balance of cleansing and exfoliation,” ElHusseini suggests.
When it comes to reducing papules and preventing the development of pustules, he says calming inflammation is absolutely crucial.
If you’re looking for home remedies, “Seek out anti-inflammatory botanicals, like cucumber, rose water, and camellia,” he says.
Meanwhile, Spierings says topical treatments, like benzoyl peroxide and salicylic acid, will get rid of bacteria on the skin that contributes to inflammation.
“Oral antibiotics are also an option and can be very effective in the short term, though they generally are not taken for more than 6 months at a time and have limited long-term efficacy,” she adds.
Nodular acne
Nodules are a severe form of acne that can be difficult to address, according to ElHusseini.
“Their appearance is similar to papules, but nodules start deeper within the layers of your skin,” he explains. “These red or skin-colored bumps never have a ‘head’ like whiteheads or pustules, but they feel firm and are painful to touch.
They can also coexist with painful cysts. This combination is called nodulocystic acne.
How to treat nodules
As nodules live deep within the skin, they can be tricky to treat. Many people may need a prescribed oral medication like isotretinoin (Accutane) to clear them up.
You may also be prescribed topical treatments, including prescription-strength benzoyl peroxide, salicylic acid, and retinoids.
While nodular acne may require a trip to the doctor’s office, ElHusseini says it’s important not to forget the basics.
“Follow a consistent skin care routine, and never try to pop nodules as this will increase your inflammation and cause scarring,” he explains.
Cystic acne
Forming below the surface of your skin, cystic acne resembles deep lumps that may be red or brown depending on your skin color. Like nodules, cysts can be painful. Unlike nodules, cysts are filled with pus.
“These are caused by the usual trifecta of excess oil, dead skin, and bacteria, and cysts are a particularly stubborn form of breakout, lingering for weeks or even months,” says ElHusseini.
How to treat cystic acne
Like nodular acne, cystic acne is unlikely to clear up with over-the-counter products alone. You’ll likely need to get a prescription from your doctor.
Common treatments for cystic acne include:
- oral antibiotics
- contraceptives
- isotretinoin
- spironolactone
It’s important to note that cystic acne is not caused by poor hygiene.
Still, “by following a nourishing skin care routine designed for acne-prone skin, cystic acne can be kept under control and future breakouts may be prevented,” ElHusseini adds.
Safety precautions
However you choose to treat your acne breakouts, it’s important you do so safely.
“Skin irritation is not necessary for the treatments to work,” Spierings points out.
The following signs indicate your routine may need some tweaking:
- redness
- burning
- flaking
- stinging
- other signs of skin irritation
If you’re pregnant or breastfeeding, always speak with a healthcare professional before starting any treatment. Many prescribed treatments for acne, including oral and topical retinoids, are not safe for those who are pregnant or breastfeeding.
